Requests for a dosette box or a Multi-compartment Compliance Aid (MCA) are common in GP practices. These requests come from patients, family, carers and other healthcare professionals. There is little evidence that these devices help patients take their medicines and no evidence that they improve patient outcomes.

The process of repeat prescribing and dispensing MCAs takes longer and is fraught with difficulties, particularly when the patient’s medicines change or when they transfer between care settings. Medicines dispensed in MCA’s cannot be used on admission to hospital as they are not easily identifiable. This leads to waste and an increased risk of errors.

They are not suitable for patients

• where there are frequent changes to their medications as the device may contain medications that have been stopped or the dose has been reduced or not contain medications that have been newly started.

Not all medicines are suitable for inclusion in these devices and this can then lead to confusion:

These include:

• Effervescent or dispersible tablets
• Medications that are sensitive to light, moisture and temperature
• Medicines taken at varying doses (e.g. warfarin, prednisolone)
• Medicines taken only when required e.g. pain relief, laxatives
• Medicines taken in a specific manner (e.g. alendronic acid, before or after food)
• Buccal and sublingual tablets
• Cytotoxic medicines
• Liquids
• Creams and topical preparations
• Inhalers
• Refrigerator items
• Dosage forms that too large or too many for the device compartment

 They should not be routinely used to support the needs of the care provider.

 The preference for patients with adherence or compliance issues is to supply medication in original packaging with appropriate adherence aids.       MCAs don’t have child resistant  closures.

They are not suitable for anyone

• Significantly affected by memory loss and/ or confusion e.g. some dementia patients are not oriented in time.
• That are poorly motivated.
• That lack the capacity to take medication due to significant physical or mental disability.
• That lacks manual dexterity to use the device.

What can be done to help?

• There are boxes that can be bought by patients to help with supporting with medications if they wish to try this option.
• Medications can be reviewed to assess if they are all still of benefit and whether there are options to be able to reduce the number of times a day medications needs to be taken.
• Medications can be aligned so they can be requested at the same time.
• Regular medication can all be issued as monthly supply to avoid excess medications lying around the house.